Terapias imunossupressoras no tratamento de COVID-19: uma revisão integrativa da literatura / Immunosuppressive therapies treatments for COVID-19: a literature review

Ana Beatriz Souza Machado, Amanda Fonseca Alves, Hállefy Ribeiro Araújo, Jhenifer Ferreira Barros, Luana Sertão Felipe Teixeira, Rodrigo Scaliante de Moura

Abstract


O atual cenário pandêmico, provocado pelo SARS-CoV-2, propiciou uma busca por tratamentos para combater a COVID-19. Como o avanço da doença está relacionado com um quadro inflamatório grave, grande parte dos medicamentos em estudo estão relacionados direta ou indiretamente com mecanismos de imunossupressão. O objetivo dessa revisão integrativa da literatura foi descrever as alternativas imunossupressoras para a COVID-19. A busca foi realizada nos bancos de dados do PubMed e LILACS por estudos que abrangiam ensaios clínicos relacionados a terapias imunossupressoras primárias ou secundárias e sua efetividade no combate ao Coronavírus. À vista disso, os tratamentos de ação primária mostraram-se promissores quanto a redução do tempo de internação, uso de ventilação mecânica e minimização dos efeitos da cascata de inflamação gerados pela COVID-19. Contudo, a mortalidade hospitalar foi mais pronunciada em pacientes graves que estavam em uso de corticosteroides do que aqueles que não fizeram uso da medicação. Outrossim, o uso das drogas de ação secundária mostrou-se pouco eficaz no combate ao vírus. Por fim, diante das análises apresentadas neste trabalho, conclui-se que a ação imunossupressora dos tratamentos estudados possuem caráter animador no combate a COVID-19.


Keywords


Infecções por Coronavirus, Fatores Imunológicos, Síndrome Respiratória Aguda Grave, Pandemias.

References


Lima CMA. O. Informações sobre o novo coronavírus (COVID-19). Radiol Bras. 2020; 53(2): V-VI. http://dx.doi.org/10.1590/0100-3984.2020.53.2e1

Errante PR, Santos GSP, Rocha VS. Coronaviroses: do SARS-COV e MERS-COV ao SARS-COV-2 (Covid-19). Revista UNILUS Ensino e Pesquisa. 2020;17(47):1-16.

Organização pan-americana da saúde. Folha informativa COVID-19 - Escritório da OPAS e da OMS no Brasil. [citado 2020 out 24]. Disponível em: https://www.paho.org/pt/covid19.

Senhoras EM. Coronavírus e o papel das pandemias na história humana. Boletim de conjuntura (BOCA). 2020;1 (1):1-6. http://dx.doi.org/10.5281/zenodo.3760078

BBC NEWS. Pandemia de coronavírus: os únicos 10 países que não tiveram nenhum caso de covid-19 até hoje. [citado 2020 out 24]. Disponível em: https://www.bbc.com/portuguese/geral-53867527.

Chen Y, Liu Q, Guo D. Emerging coronaviruses: Genom estructure, replication, and pathogenesis. J Med Virol. 2020;92(4):418-423. https://doi.org/10.1002/jmv.25681

Quintella CM, Silva LAC, Quintella HM, Silva GHR, Silva SCR, Silva SCR, et al. Fármacos para COVID-19: muito além da cloroquina (testes clínicos para o coronavírus SARS-CoV-2). Cadernos de Prospecção-Salvador. 2020;13(3):599-618. http://dx.doi.org/10.9771/cp.v13i3.36815

Edalatifard M, Akhatari M, Salehi M, Naderi Z, Jamshidi A, Mostafaei S, et al. Intravenous methylprednisolone pulse as a treatment for hospitalised severe COVID-19 patients: results from a randomized controlled clinical trial. Eur Respir J. 2020;56(5)1-34. https://doi.org/10.1183/13993003.02808-2020

Tomazini BM, Maia IS, Cavalcanti AB, Berwanger O, Rosa RG, Veiga VC, et al. Effect of dexamethasone on days alive and ventilator-free in patients with moderate or severe acute respiratory distress syndrome and COVID-19: the CoDEX randomized clinical trial. Jama. 2020;324(13):1307-1316. 10.1001/jama.2020.17021

Wu J, Huang J, Zhu G, Liu Y, Xiao H, Zhou Q, et al. Systemic Corticosteroids and Mortality in Severe and Critical COVID-19 Patients in Wuhan, China. J Clin Endocrinol Metab. 2020;105(12):1-10. https://doi.org/10.1016/S0140-6736(20)31862-6

Dequin PF, Heming N, Meziani F, Plantefève G, Voiriot G, Badié J, et al. Effect of hydrocortisoneon 21-Day mortality or respiratory support among critically ill patients with COVID-19: a randomized clinical trial. Jama. 2020;324(13):1298-1306. 10.1001/jama.2020.16761

Sengupta V, Sengupta S, Lazo A, Woods P, Nolan A, Bremer N. Exosomes Derived from Bone Marrow Mesenchymal Stem Cells as Treatment for Severe COVID-19. Stem Cells and Dev. 2020; 29(12):747-754. https://doi.org/10.1089/scd.2020.0080

Asgharpour M, Mehdinezhad H, Bayani M, Zavareh MSH, Hamidi SH, Akbari R, et al. Effectiveness of extracorporeal blood purification (hemoadsorption) in patients with severe corona virus disease 2019 (COVID-19). BMC Nephrol. 2020;21(356):1-11. https://doi.org/10.1186/s12882-020-02020-3

West TA, Malik S, Nalpantidis A, Tran T, Cannon C, Bhonagiri D, et al. Tocilizumab for severe COVID‐19 pneumonia: Case series of 5 Australian patients. Int J Rheum Dis. 2020;23(8):1030-1039. https://doi.org/10.1590/0100-3984.2020.53.2e1

Ramiro S, Mostard RLM, Magro-Checa C, Van Dongen CMP, Dormans T, Buijis J, et al. Historically controlled comparison of glucocorticoids with or without tocilizumab versus supportive care only in patients with COVID-19-associated cytokine storm syndrome: results of the CHIC study. Ann Rheum Dis. 2020;79(9):1143-1151. https://doi.org/10.1186/s13063-020-04478-w

Morena V, Milazzo L, Oreni L, Bestetti G, Fossali T, Bassoli C, et al. Off-label use of tocilizumab for the treatment of SARS-CoV-2 pneumonia in Milan. Italy. Eur J Intern Med. 2020;76:36-42. https://doi.org/10.1016/j.ejim.2020.05.011

Xu X, Han M, Li T, Sun W, Wang D, Fu B, et al. Effective treatment of severe COVID-19 patients with tocilizumab. Proc Natl Acad Sci U S A. 2020;117(20):10970-10975. https://doi.org/10.1073/pnas.2005615117

Carvalho SGC. Estudos estruturais e funcionais de diidroorotatodesidrogenases. São Paulo. Tese (Doutorado- Programa de Pós-Graduação em Ciências. Área de concentração: Física Aplicada) - Instituto de Física de Sâo Carlos; 2008. 10.11606/T.76.2008.tde-05052008-152108

Wang M, Zhao Y, Hu W, Zhao D, Zhang Y, Wang T, et al. Treatment of COVID-19 Patients with Prolonged Post-Symptomatic Viral Shedding with Leflunomide -- a Single-Center, Randomized, Controlled Clinical Trial. Clin Infect Dis. 2020; 1-21. https://doi.org/10.1093/cid/ciaa1417

Hu K, Wang M, Zhao Y, Zhang Y, Wang T, Zheng Z, et al. A Small-Scale Medication of Leflunomide as a Treatment of COVID-19 in an Open-Label Blank-Controlled Clinical Trial. Virol Sin. 2020;1-9. https://doi.org/10.1007/s12250-020-00258-7

Lussana F, Cattaneo M, Rambaldi A, Squizzato A. Ruxolitinib-associated infections: A systematic review and meta-analysis. Am J Hematol. 2018;93(3)339-347. https://doi.org/10.1002/ajh.24976

Cao Y, Wei J, Zou L, Jiang T, Wang G, Chen L, et al. Ruxolitinib in treatment of severe coronavirus disease 2019 (COVID-19): A multicenter, single-blind, randomized controlled trial. J Allergy Clin Immunol. 2020;146(1):137–146. https://doi.org/10.1016/j.jaci.2020.05.019

Rosée F, Bremer HC, Gehrke I, Kehr A, Hochhaus A, Birndt S, Fellhauer M, Henkes M, Kumle B, Russo SG, La Rosée P. The Janus kinase ½ inhibitor ruxolitinib in COVID-19 with severe systemic hyperinflammation. Leukemia. 2020;34(7):1805-1815. https://www.nature.com/articles/s41375-020-0891-0

Sekhavati E, Jafari F, SeyedAlinaghi S, Jamalimoghadamsiahkali S, Sadr S, Tabarestani M, et al. Safety and effectiveness of azithromycin in patients with COVID-19: An open-label randomised trial. Intern J Antimicrob Agents. 2020;56(4):1-8. https://doi.org/10.1016/j.ijantimicag.2020.106143

Boulware DR, Pullen MF, Bangdiwala AS, Pastick KA, Lofgren SM, Okafor EC, et al. A randomized trial of Hydroxychloroquine as post exposure prophylaxis for Covid-19. N Engl J Med.2020; 383:517-525. 10.1056/NEJMoa2016638

Furtado RHM, Berwanger O, Fonseca HA, Corrêa TD, Ferraz LR, Lapa MG, et al. Azithromycin in addition to standard of care versus standard of care alone in the treatment of patients admitted to the hospital with severe COVID-19 in Brazil (COALITION II): a randomized clinical trial. The Lancet. 2020;396(10256):959-967. https://doi.org/10.1016/S0140-6736(20)31862-6

Lauriola M, Pani A, Ippoliti G, Mortara A, Milighetti S, Mazen M, et al. Effect of Combination Therapy of Hydroxychloroquine and Azithromycin on Mortality in Patients With COVID‐19. Clin Transl Sci. 2020; 1-17. https://doi.org/10.1111/cts.12860

Gautret P, Lagier JC, Parola P, Hoang VT, Meddeb L, Mailhe M, et al. Hydroxychloroquine and azithromycin as a treatment of COVID-19: results of an open-label non-randomized clinical trial. Int J Antimicrob Agents. 2020;56(1):1-6. https://doi.org/10.1016/j.ijantimicag.2020.105949

Sekhavati E, Jafari F, SeyedAlinaghi S, Jamalimoghadamsiahkali S, Sadr S, Tabarestani M, et al. Safety and effectiveness of azithromycin in patients with COVID-19: An open-label randomised trial. Intern J Antimicrob Agents. 2020;56(4):1-8. https://doi.org/10.1016/j.ijantimicag.2020.106143

Miller J, Bruen C, Schnaus M, Zhang J, Ali S, Lind A, et al. Auxora versus standard of care for the treatment of severe or critical COVID-19 pneumonia: results from a randomized controlled trial. Crit Care. 2020;24(502):1-9. https://doi.org/10.1186/s13054-020-03220-x




DOI: https://doi.org/10.34119/bjhrv4n2-087

Refbacks

  • There are currently no refbacks.